SM184 Anovulation

Question 1

Define amenorrhea

Answer 1

Menses > 6 months

Question 2

Define oligomenorrhea

Answer 2

Menses 35 days - 6 months

Question 3

Most common cause of secondary amenorrhea

Answer 3

Pregnancy

Question 4

Effect of breast feeding on menstruation

Answer 4

Prevents it

Question 5

What hormone in contraceptives cause amenorrhea?

Answer 5

Progestin (synthetic progesterone) in OCPs, progestin-only pill, progestin injections, implants, and IUDs

Induces endometrial atrophy

Question 6

Most common endocrine disorder in women

Answer 6

PCOS

Question 7

FSH functions

Answer 7

Stimulates granulosa cell proliferation

Stimulates aromatase and estradiol

Increases granulosa cell FSH and LH receptors

Produces autocrine-paracrine factors, especially activin and inhibin

Question 8

What causes LH surge?

Answer 8

Estradiol positive feedback

Question 9

Hypogonadotropic hypogonadism

Answer 9

Stress, weight loss, and exercise

Low/normal FSH and LH

Hypoestrogenic

Thin endometrial stripe, failure to withdraw to progestins, immature vaginal cytology, low estradiol level

Question 10

Hypogonadotropic hypogonadism treatment

Answer 10

Lifestyle modification

Ovulation induction with human menopausal gonadotropins with LH and FSH

Question 11

Hyperprolactinemia

Answer 11

Most common pituitary cause of secondary amenorrhea

Check TSH to rule out hypothyroidism

Pregnancy/breast feeding

Drug history

MRI

Question 12

Drugs that induce hyperprolactinemia

Answer 12

Antipsychotics: phenothiazines, haldoperidol, clozapine, olanzapine, risperidone

Question 13

PCOS

Answer 13

Androgen excess (hirsutism, acne), insulin resistance, anovulation

Ovary with 12 or more follicles 2-9 mm in diameter

Question 14

PCOS treatment

Answer 14

Anovulation: OCP, SERMs (clomiphene citrate), aromatase inhibitors (letrozole anastrozole), gonadotropin injections

Hirsutism: OCP and spironolactone

Insuline resistance: OGTT, weight loss, metformin

Question 15

Premature ovarian failure

Answer 15

Menopause before 40

Two FSH levels > 40 one month apart

Treatment: oocyte donation

Question 16

Fragile-X pre-mutation

Answer 16

15% have primary ovarian failure

Question 17

POF genetic testing

Answer 17

Karyotype: under age 30 or less than 60” (look for Turner or mosaics)

Fragile-X analysis in all under 40

Question 18

Asherman’s syndrome

Answer 18

Trauma to the basal layer of the uterus, usually following a D&C

Question 19

No breast development + uterus present

Answer 19

FSH high: gonadal dysgenesis

FSH low: hypogonadotropic hypogonadism

Question 20

Breast development + uterus present

Answer 20

XX: congenital absence of the uterus (Mayer-Rokitansky-Kuster-Hauser)

XY: androgen insensitivity syndrome

Question 21

No breast development + no uterus

Answer 21

Rarest primary amenorrhea

Karyotype: 46XY

LH receptor mutation, 17,20-lyase deficiency

Question 22

Breast and uterus present: normoestrogenic

Answer 22

Androgen excess: PCOS

Normal androgens: atypical PCOS, mild hypogonadotropic hypogonadism

Question 23

Breast and uterus present: hypoestrogenic

Answer 23

Low FSH: hypogonadotropic hypogonadism

High FSH: POF